Pioneering Era of Bilateral Mammary Artery for CABG in Germany—Over 20 Years Clinical Follow-Up

Background: The evidence of long-term outcomes after bilateral mammary artery (BIMA) use for coronary artery bypass grafting (CABG) before the beginning of massive utilization of coronary stenting in patients with coronary artery disease (CAD) is lacking.

Our institution was one of the pioneers in use of BIMA for CABG in Germany, in times where stenting of coronary arteries for CAD was not widespread. We conducted long-term clinical follow-up of this period.

Methods: We identified in our archives 427 patients who underwent CABG using BIMA for CAD between 1989 and 1993. The primary end-point was all-cause mortality. Second end-points were: a composite of all-cause mortality, myocardial infarction and repeat revascularization, a composite of all-cause mortality and stroke and cardiac cause of mortality. 73 patients were lost to follow-up. 354 patients were included in the study. The mean follow-up time was 18.4 ± 0.8 years.

Results: The mean age was 57 ± 8.8 years. Men were 312 (88%) of patients. The mean EuroScore II was 1.5 ± 0.7%. The preoperative baselines were significant for presence of hyperlipidemia as well as smoking, 78% and 71%, respectively. Prior to CABG no patients underwent stenting of coronary arteries. Balloon dilation or lysis therapy underwent 18% of the patients.

The overall 5-, 10-, 15-, and 20-year survival rates were 99, 92, 84, and 75%, respectively. The 5-, 10-, 15- and 20-year rates of freedom from a composite of all-cause mortality, myocardial infarction and repeat revascularization were 95, 85, 75, and 63%, respectively. The 5-, 10-, 15- and 20-year rates of freedom from a composite of all-cause mortality and stroke were 98, 90, 80 and 70%, respectively. The overall 5-, 10-, 15- and 20-year cardiac cause of mortality rates were 0.3, 3.9, 8.1 and 10.6%, respectively. The overall repeat revascularization rate after 20 years was 11.6%. No patients underwent redo surgery. All patients underwent percutaneous interventions.

Conclusion: Pioneer efforts in Germany to treat CAD utilizing CABG with BIMA, often as a first line therapy, shows excellent 20-year outcomes with very low need for repeat revascularization.

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Artikel online veröffentlicht:
13. Februar 2024